Provider Demographics
NPI:1003815390
Name:BURNETTE, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G
Other - Middle Name:EDWARD
Other - Last Name:BURNETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0790
Mailing Address - Country:US
Mailing Address - Phone:606-666-6607
Mailing Address - Fax:
Practice Address - Street 1:424 JETT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-9621
Practice Address - Country:US
Practice Address - Phone:606-666-6000
Practice Address - Fax:606-666-6107
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64204142Medicaid
KY0384410Medicare PIN